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Published on: August 4, 2010
Acute kidney injury following intravenous acyclovir in children
Blake J Sandery1,2, Jonathan H Erlich3,4, Sean E Kennedy5,2
1Nephrology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia blake.sandery@cw.bc.ca.
Insights
Acute kidney injury (AKI) is common in children treated with intravenous acyclovir. High baseline estimated glomerular filtration rate (eGFR) is a significant risk factor for developing AKI, suggesting glomerular hyperfiltration may be a key contributor.
Area of Science:
- Pediatric Nephrology
- Pharmacology
- Clinical Research
Background:
- Intravenous acyclovir is frequently used in pediatric patients.
- Acute kidney injury (AKI) is a potential adverse effect of acyclovir.
- Identifying risk factors for AKI in children is crucial for safe medication use.
Purpose of the Study:
- To determine the incidence of AKI in children receiving intravenous acyclovir.
- To identify risk factors associated with AKI in this pediatric population.
Main Methods:
- Retrospective cohort study utilizing chart review.
- Inclusion of pediatric inpatients who received intravenous acyclovir between January 2015 and December 2015.
- Analysis of creatinine measurements before and after acyclovir initiation to define AKI.
Main Results:
- 18% of 150 pediatric patients developed stage 1 AKI.
- Children receiving cancer treatment had a higher incidence of AKI (29.3%) compared to others (10.9%).
- A higher baseline estimated glomerular filtration rate (eGFR) (>120 mL/min/1.73 m²) was a significant predictor of AKI (OR 3.6).
Conclusions:
- AKI following intravenous acyclovir is a common complication in children.
- Elevated baseline eGFR, indicative of glomerular hyperfiltration, is a novel risk factor for acyclovir-induced AKI in children.
Objective:
The objective of this study was to describe the incidence of acute kidney injury (AKI) in children receiving intravenous acyclovir and determine risk factors that may be associated with it.
Design:
This was a retrospective cohort study, conducted by chart review.
Setting:
The study was conducted across two paediatric hospitals.
Patients:
All inpatients that received intravenous acyclovir in records from January 2015 to December 2015 were reviewed. Only patients with creatinine measurements taken before and after starting acyclovir were included in the study.
Main Outcome Measures:
The main outcome measure was the development of AKI following intravenous acyclovir administration, with AKI defined according to change in serum creatinine.
Results:
150 patients were included in the analysis. Patients' ages ranged from 2 days to 18.6 years. 27 children (18%) developed at least stage 1 AKI. Children receiving cancer treatment developed AKI more frequently than children with other diagnoses; 29.3% vs 10.9% (OR 3.4, 95% CI 1.5 to 8.2, p=0.008). The baseline estimated glomerular filtration rate (eGFR) was higher in those children who developed AKI. 34% of children had an eGFR >120 mL/min/1.73 m2 prior to acyclovir use. 31% of these children developed AKI compared with only 11% of those with a normal baseline eGFR (OR 3.6, 95 CI 1.3 to 10.1, p=0.02). Baseline eGFR was a significant predictor of AKI in a multivariable analysis that included cumulative dose and treatment duration (OR 1.02, p=0.013).
Conclusion:
AKI following intravenous acyclovir exposure is common in children. This study raises the possibility that glomerular hyperfiltration is a previously unrecognised risk factor for acyclovir-induced AKI.
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